The extremities, particularly a hand and an arm, are organs composed of bones, muscles, ligaments, tendons, blood vessels, nerves, the skin, and the like and have a very variegated motion and delicate sense, indispensable organs in all human activities from everyday life to creative activity. Furthermore, a hand, which also plays an important role for expression of emotion or an intention, is viewed as a very high sociality organ. Restoration of a hand or reconstruction of a function requires a reconstruction of sophisticated functions and esthetics, prompting the training of specialists (hand surgeons and hand therapists) who specialize in this field in every country in the world.
Further, the hand is an anatomical site to which an externally caused injury occurs most frequently, and as many as 12% of the American emergency patients are hand surgery patient candidates. Further, a hand is a frequent site for work-related musculoskeletal disorders, such as a carpal tunnel syndrome, stenosing tenosynovitis, tennis elbow, and the like, totaling as many as 64% of all work-related musculoskeletal disorders, with the cost of the medical treatment allegedly estimated at 270 billion dollars, and the number of cases is also annually on the rise. However, these diseases occur not just among male workers, but also frequently among middle-and-advanced aged women, mostly housewives. For this reason, it is estimated that female patients are numbered about three times as much as male patients. According to a recent epidemiological research on a most frequent carpal tunnel syndrome, the incidence rate in general population is said to be about 2.7% of the adult population, and the annual number of surgery cases amounts to 200,000 cases in the United States.
Furthermore, for hand surgery, osteoarthritis (estimated to be 70 million patients in the United States) is the 3rd most frequent next to a knee joint and a hip joint, and it is the highest site in the frequency of the inflammatory arthritis exemplified by articular rheumatism.
Although hand surgery demands ample knowledge and experience, and sophisticated medical technique, recovery of the expected function fails to occur unless post operative after-treatment is appropriate, no matter how outstanding the operation was. The most important factors to look for in after-treatment are postoperative edema and pain control. A hand beings a site which is very prone to swell after an externally caused injury or operation, a negligent control, will cause contraction of a ligament or the joint capsule, adhesion of a tendon, nerve strangulation, and the like, lapsing into a serious functional disorder. Further, the incidence of circulatory disorders, unless caught and treated early, will cause a tissue necrosis or muscle's ischemic contracture resulting in a useless hand.
Thus, in the medical treatment after an externally caused injury or an operation of a hand, it is important how one controls a pain and maintains good circulation while controlling edema; further it is also necessary for contracture prophylaxis and recovery of function to start active motion of fingers at an early stage as much as possible.
For this reason, this makes the measures against edema at an early stage after injury or an operation the most important treatment common to all hand surgery operations.
The current therapy for edema control extensively relies on a compressive bulky dressing for an early stage edema control after an injury or operation. The method specifically calls for placing a number of thick gauze layers uniformly around the hand, inserting gauze between the fingers to the extent of not obstructing circulation, and loosely fastening over the layers with an elasticity bandage. Compressive bulky dressing, if executed appropriately, will uniformly press the whole hand and control edema formation. Furthermore, relief of edema is further expedited by keeping the hand from the elbow higher than the heart, thereby easing venous and lymphatic perfusion. In addition, the patient is asked to perform active motion of the fingers within the compressive bulky dressing, so as to further activate venous and lymphatic perfusion. Further, various devices have been reported on encouraging the patient to raise the arm and move the fingers while in use of this dressing method.
It should be noted that the conventional compressive bulky dressing has various shortcomings as shown below.
It does not allow checking how much pressure is being applied or whether the pressure is distributed uniformly or not. It is difficult to long maintain the pressure initially exerted when worn, and the dressing may come to loosen or tighten excessively.
It makes finger motion difficult to do due to interference from the gauze.
It neither allows observing the wounded site nor monitoring inflammation, circulatory disorder, or the like.
It does not allow controlling temperature, preventing cooling or warming as needed.
It makes the arm to be held elevated at all times, which keeps the patient restrained.
Nevertheless, presently with no alternative method as yet developed to replace the compressive bulky dressing, this method, while facing these deficiencies, continues to prevail widely as an established standard medical treatment procedure.